Who will write it?

I agree - you can't rely on good-will and hobyists to write stuff for thr NHS - that's just silly.

But of the software that something like the NHS uses, a lot of it, like word processors, terminal emulators (!), databases, etc etc IS available off-the-shelf for free. Yes, of course it will take money to configure it and get it running, but that's true of whatever software you use - you can't just take an SQL server and it works for you - you need to invest effort into it. And (and this is the crucial thing), you damn well make sure that you (the NHS) retain any rights over any configuration work that is done; you don't want to be locked-in for the next hundred years into going back to the original supplier.

As for the rest, I bet a lot of the software is either bespoke or very heavily modified/configured stuff. In which case, it's no harder to write it to use a free platform (for example) than it is to use an expensive one. And again, you make sure you retain the rights.

Clearly the procurement people are simply not driving a hard enough bargain in this respect, because lock-in is as serious an issue today as it was back in the 70s and 80s when IBM were eventually stuffed-up for doing exactly this. Lessons seem not to have been leaned. Maybe the procument people don't actually know what they are doing? Could this be true? Surely not!!